Nha - Certified Billing And Coding Specialist (Cbcs) Study Guide Questions And Answers (2024 / 2025) (Verified Answers)

Referral {Ans: Written recommendation to a specialist.}What is an example of Medicare abuse? {Ans: Charging excessive fees.}Formulary {Ans: A list of prescription drugs covered by an insurance plan.}Subscriber {Ans: Purchaser of the insurance or the member of group for which an employer or association as purchased insurance.}Coinsurance {Ans: the pre-established percentage of expenses paid by the insurance company after the deductible has been met.}Implied Consent {Ans: A patient presents for treatment, such as extending an arm to allow a venipuncture to be performed.}Unbundling {Ans: Using multiple codes that describe different components of a treatment instead of using a single code that describes all steps of the procedure.}Upcoding {Ans: Assigning a diagnosis or procedure code at a higher level than the documentation supports, such as coding bronchitis as pneumonia.}What type of insurance is considered the payer of last resort? {Ans: Medicaid}What color format is acceptable on the CMS-1500 claim form? {Ans: Red}Medicare {Ans: Federally funded health insurance provided to people age 65 or older, and people 65 and younger with certain disabilities.}Notice of Exclusions from Medicare Benefits {Ans: Notification by the physician to a patient that a service will